Code guide · Initial assessment
0591T: the health coaching initial assessment
How CPT® 0591T works under the CY 2027 Medicare Physician Fee Schedule Final Rule, and what a coach should document in the first session.
Short answer
0591T is the Category III CPT code for an individual, face-to-face health and well-being coaching initial assessment. From January 1, 2027, Medicare pays for it nationally under the Physician Fee Schedule. A qualified coach furnishes it as auxiliary personnel under the general supervision of a physician or other practitioner, and only that supervising practitioner bills Medicare (42 CFR 410.26(b)(5)).
0591T at a glance
| Service | Health and well-being coaching, face-to-face, individual, initial assessment (CMS Table A-D9 wording) |
|---|---|
| Time | CMS's final-rule table lists no time for 0591T. Use the current AMA CPT® descriptor.1 |
| Payment status (CY 2027) | Status A: nationally priced, separately paid. Previously contractor priced. |
| Final work RVU | 1.81 (proposed 1.00), crosswalked to CPT 99487 |
| Estimated national payment | About $137.69 non-facility / $75.05 facility2, paid to the billing practitioner |
| Who furnishes | Auxiliary personnel with appropriate certification, under general supervision |
| Who bills | Only the supervising physician or other practitioner |
| Telehealth | On the Medicare Telehealth Services List (CY 2027 action: "Maintain") |
| Frequency limit | None set, as long as services are reasonable and necessary |
1 The "60–90 minutes" wording appears only where the rule restates the original proposal (display copy p. 375). Table A-D9 (p. 436) gives no time for 0591T. 2 Estimates calculated from Addendum B total RVUs (4.22 non-facility, 2.30 facility) × the rule's estimated conversion factor of 32.6286. Not CMS-published; actual payment varies by locality and setting.
A Category III code, now nationally priced
The AMA CPT® Editorial Panel created 0591T–0593T as Category III codes, which track emerging services; CMS notes they have been in effect since January 1, 2020 (rule p. 378). Until 2027, Medicare payment was set contractor by contractor. The CY 2027 rule gives them national Physician Fee Schedule values under Medicare Part B. CMS considered creating HCPCS G-codes instead and declined, keeping the Category III codes because they are recognized nationally (p. 386).
What 0591T covers
0591T is the first coaching encounter. CMS adopted the CPT prefatory language for these codes, which describes coaching as a patient-centered approach: the patient sets the goals, uses self-discovery and active learning alongside health education, and self-monitors behavior, within a relationship with a coach (rule pp. 375–376).
In practice, the initial assessment is where the coach and patient establish what matters to the patient, readiness to change, values, and the first goals. It connects to the condition and plan of care the supervising practitioner has already documented. Follow-up sessions are reported with 0592T; group sessions with 0593T.
Who can furnish 0591T, and who bills it
The coach is auxiliary personnel furnishing the service incident to a physician's or other practitioner's services. CMS finalized general supervision for coaching, so the practitioner does not need to be physically present (rule pp. 380–381; 42 CFR 410.26(b)(5)(iii)). Only the supervising practitioner may bill (410.26(b)(5)(v)).
CMS requires appropriate certification and lists pathways that "include, but are not limited to" NBHWC National Standards, NCHEC eligibility for Certified Health Education Specialists, AHNCC Certified Nurse Coach standards, and training from Older Americans Act evidence-based programs (rule pp. 382–383). See CHES® and MCHES® under the 2027 rule for the credential questions.
Documenting the initial assessment
The rule's coaching section lists no coaching-specific documentation elements. The workflow below follows general incident-to and time-based documentation practice. Your supervising practitioner's and organization's policies come first.
- Before the session: confirm the practitioner's order or plan of care that the coaching carries out, and that the coach's credential file is current.
- During the session: record actual start and stop times and the modality (in person, audio-video or audio-only).
- Subjective: the patient's own goals, what matters to them, readiness and confidence, and barriers.
- Objective: time, modality, and any tools used (for example a readiness ruler).
- Assessment: where the patient stands relative to the practitioner's plan, within coaching scope. Coaches do not diagnose.
- Plan: first SMART goals, the next session, and any new clinical concern referred back to the practitioner.
- Sign-off: coach name, credential and signature; supervising practitioner named.
Fictional example (annotated)
Note type: Health coaching initial assessment · Modality: audio-video · Time: [actual start]–[actual stop]
S: Patient states the goal is "to walk with my grandkids without stopping." Rates readiness 7/10, confidence 5/10. Barrier: evening shift schedule.
O: Readiness ruler completed. Order from Dr. [name] dated [date] on file.
A: Motivated; goal aligns with the practitioner's plan for [condition from plan]. No new clinical concerns raised.
P: Walk 10 minutes after breakfast, 4 days/week. Follow-up in 2 weeks. Coach: [name, credential]. Supervising practitioner: [name].
Bracketed fields are placeholders, not defaults. Never pre-fill times, medical-necessity language or outcomes; record what actually happened in each session.
Common 0591T mistakes
- Treating the coach as the biller. The claim belongs to the supervising practitioner; the coach's note supports it.
- No practitioner order or plan on file. The coaching should carry out a plan the practitioner documented.
- Quoting "60–90 minutes" as the rule. That wording came from the proposal. Use the current CPT® descriptor and record actual time.
- Templated or pre-filled notes. Cloned text, default times and boilerplate medical-necessity language undermine the record.
- Coaching past scope. New symptoms, medication questions and mental-health crises go back to the practitioner.
- Skipping same-day edit checks. Run claims against National Correct Coding Initiative (NCCI) edits and your MAC's policies.
0591T vs 0592T vs 0593T
| Code | Use it for | Final work RVU |
|---|---|---|
| 0591T | Individual initial assessment | 1.81 |
| 0592T | Individual follow-up session, at least 30 minutes | 1.00 |
| 0593T | Group of 2 or more, at least 30 minutes, billed per beneficiary | 0.23 |
Frequently asked questions
What does CPT 0591T cover?
An individual, face-to-face health and well-being coaching initial assessment, as described in the CPT code set and adopted by CMS for CY 2027 payment.
Who can bill 0591T?
Only the supervising physician or other practitioner. Coaches, including CHES®, MCHES® and NBC-HWC professionals, furnish the service as auxiliary personnel and are not independent Medicare billers.
Can 0591T be furnished by telehealth?
The code remains on the CY 2027 Medicare Telehealth Services List. Confirm modality, place-of-service and modifier requirements with your MAC and current CMS telehealth instructions.
How long must a 0591T session be?
CMS's final table lists no time for 0591T. Follow the current AMA CPT® descriptor and your MAC's guidance, and document actual start and stop times.
How much does Medicare pay for 0591T?
About $137.69 national non-facility (estimate from Addendum B RVUs; not a CMS-published figure). Payment goes to the billing practitioner, varies by locality and setting, and depends on coverage and medical necessity.
Sources: CMS-1848-F public-inspection display copy (pp. 374–387, 436, 2059–2060); CY 2027 Addendum B (updated Nov 5, 2026); CY 2027 Medicare Telehealth Services List. Page numbers are display-copy pages until the Federal Register version is published. CPT® is a registered trademark of the American Medical Association; descriptors are paraphrased.